The physician quality reporting initiative - A gateway to pay for performance: What every health care professional should know

Jonah Stulberg*

*Corresponding author for this work

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

The Physician Quality Reporting Initiative (PQRI) is a pay-for-reporting (P4R) program sponsored by the Centers for Medicare & Medicaid Services open to all health care providers that treat Medicare patients. This P4R initiative provides financial incentives for participation and unlike most pay-for-performance (P4P) programs, there are no penalties for poor performance. PQRI therefore offers Medicare providers nationwide a low-risk opportunity to gain experience with reporting procedures likely to be incorporated into P4P reimbursement schemes. The 74 measures used during the first reporting period are applicable to both generalist and specialist providers and open participation in PQRI to a much broader audience compared with previous federal initiatives. Also in contrast to programs that measure hospital or group quality and reimburse for services at the health system level, measurement and reimbursement in PQRI directly affects individual Medicare providers. The combination of provider-level measurement and reimbursement and efforts to assess care delivered by both generalist and specialist Medicare providers highlights how this P4R initiative is truly a gateway to a P4P reimbursement system. Participation in the PQRI program provides useful experience to Medicare providers and their staff in preparing for future initiatives that try to tie quality to reimbursement.

Original languageEnglish (US)
Pages (from-to)2-8
Number of pages7
JournalQuality Management in Health Care
Volume17
Issue number1
DOIs
StatePublished - Jan 1 2008

Keywords

  • health care quality
  • health care reimbursement
  • pay for performance
  • pay for reporting
  • quality reporting

ASJC Scopus subject areas

  • Leadership and Management
  • Health(social science)
  • Health Policy
  • Care Planning

Fingerprint Dive into the research topics of 'The physician quality reporting initiative - A gateway to pay for performance: What every health care professional should know'. Together they form a unique fingerprint.

  • Cite this